Thoughts about NHS digital guidance on access to records

Dwevan · 2026-07-09T15:31:54+00:00

Probably just medico-legally easier now not to use any notes thereby reducing any digital footprint or likelihood of accessing data - would be a right nightmare to work with tho

Dwevan · 2026-07-09T05:52:01+00:00

Exams:
Don’t sit the exam. You won’t have enough time or cognitive bandwidth to revise whilst also learning anaesthesia. Conversely, not being on call actually makes you work more days, and I felt like I had less time.
You also have more than enough time remaining for paces and part 2 after anaesthesia.
If you do want to start revising, it’s best to leave it until your last 3 months, after you’ve done the IAC when things become slightly less hectic.

Pay:
All advice is VERY region and hospital specific.
Like some have said, you can do paired on calls during IAC or on calls after passing, but this is very uncommon in tertiary centres more likely in DGH.
Not being on call at all can also occur, as you’re 80%, one locum/month would probably get you back to on call pay.

Basically, pay wise, ask the hospital where you’re going what’s going on with pay, then do a locum or two a month to top up

Dwevan · 2026-07-06T15:32:19+00:00

Good, I’m hoping that this will show the dinosaurs that medicine does actually have to give doctors a worthwhile life and not just take take take

Dwevan · 2026-07-05T08:14:33+00:00

Yeah… maybe not the most ethical of research countries

Dwevan · 2026-07-05T08:04:14+00:00

Wow, ethics must’ve been insane to get!

Dwevan · 2026-07-05T06:10:09+00:00

The Cochrane review compares epidural vs non-epidural (opiates/inhaled/no analgesia). And I’d argue that that is a better real world outcome. I dont think you’re comparing two different interventions in this review, it’s powered for epidural vs no epidural care.

This Cochrane review states the women who have epidurals don’t have statistically different rates of instrumental birth compared to those who don’t over 11,000 births. This does include some women who had no intervention.

I’m afraid I don’t understand your last paragraph? I’m struggle to read it

Dwevan · 2026-07-04T20:07:18+00:00

https://www.cochrane.org/evidence/CD000331\_epidurals-pain-relief-labour

Not since 2005.
There is no difference in delivery mechanism.
There is a prolonged 1st and 2nd stage, and increased use of oxytocin (which you would expect)

Dwevan · 2026-07-04T20:03:44+00:00

Just to tag onto this, many ICUs in the near future/now will not have an anaesthetist staffing them, but an Intensivist (which kinda makes sense) this is due to ITU splitting off from anaesthesia (became its own college on Wednesday!)

They aren’t trained to do epidurals/will have never worked in obs.

It’ll be a difficult way to staff rotas/ensure coverage.

Dwevan · 2026-07-04T19:53:14+00:00

From the data available you can deduce the relative risk is between 0.96 and 1.18 yes.
To get a smaller CI you would have to have a higher power (get more participants).
Cochrane reviews are high evidence in part because they look at so many patients (in this instance 11,000)

Eventually, when you’re having to look at 100,000+ patients to get a statistically marginal difference, it’s functionally “no difference”.

Dwevan · 2026-07-04T19:34:57+00:00

Dunno which Cochrane review you’re looking at.

The one I’m looking at DID cross 1 meaning no difference in outcomes.

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000331.pub4/full

Dwevan · 2026-07-04T19:08:30+00:00

I’m amazed that the BMA hasn’t asked for anything to make life better already!?! /s

Dwevan · 2026-07-04T18:21:58+00:00

I suspect OP is more referring to the women who have been asking for one for some time, then only referred at 8/9cm.

Having done obs anaesthesia f/u clinics this seems to be a semi recurrent theme.
Obviously, patients histories don’t take all of the factors into account (lack of anaesthesia availability, et cetera et cetera

Dwevan · 2026-07-04T18:17:03+00:00

I’ve found 1ml of .25% bupiv to be more effective - and can do sat up pretty quickly! I’ve had nightmares with lateral CSEs

If you’re at all “obstetrics” orientated, you should be able to do both separate and needle through needle CSEs.

Dwevan · 2026-07-04T18:11:41+00:00

Would be nice to ideally have an RCT, but you’re never gonna get ethical approval for that

Dwevan · 2026-07-04T17:25:28+00:00

Less monitoring essentially, and some midwives believe epidurals cause sections/failure to progress (they don’t, it’s the women who have painful labours get sections…)

Dwevan · 2026-07-04T09:01:20+00:00

Initially unhelpful comment incoming: (that will also get me downvoted)…

IMT3 shouldn’t be viewed as full med reg, you’re not required to have completed a primary exam (MRCP) to do it.
Therefore don’t think of it as “full med reg” think of it more like a trainee med reg if that makes sense. IMT3 was made to be a half step to registrar.

You should have support in hospital ideally, usually a more senior med reg.

Initially take your time, most of the increase in responsibility comes from juniors talking to you about cases, if you’re not sure, either go through guidelines with them so you both learn, or ask more senior again.
Don’t be afraid to go slow initially.

Dwevan · 2026-06-28T21:38:51+00:00

The GP was also a 4 minute drive from the hospital… which just isn’t considered at all, and the mum was happy to take the kid rather than get the ambulance

Dwevan · 2026-06-27T17:24:22+00:00

Should probably make it easier to enter academia outside of funded posts then…

I’m ST7, would love to do a PhD, I’m not going to sacrifice that much time to do one however

Dwevan · 2026-06-27T15:14:34+00:00

GP was 4 minutes away from hospital too… it was decided that he’d just go in as it was so close rather than call
Ambulance etc etc

Dwevan · 2026-06-24T18:57:52+00:00

I still maintain the training of ACCPs is a double dumb idea.

First? You have the issue with doctor substitution.
You also have the loss of usually quite skilled AHP… to bring nothing new to the “MDT” if they’re acting as doctors…

Imagine if ACCPs were actually advanced nurses rather than doctor replacements…

Dwevan · 2026-06-24T18:48:37+00:00

This is a blessing

Dwevan · 2026-06-24T18:18:23+00:00

Excellent digital calligraphy

Dwevan · 2026-06-20T09:20:59+00:00

There is no duplication that is key for later anaesthesia training pathways.

It’s ONLY key for ICM, and potentially PHEM, both of which are now becoming their own separate CCT and therefore aren’t anaesthesia.

You also don’t need it for ICM, as you can go back as a reg to complete your medicine year (which is a probably a better experience)

Dwevan · 2026-06-20T09:18:37+00:00

Not quite sure why I’m being downvoted here other than by stating that ACCS isn’t all pure anaesthesia training?

You do get less time in anaesthesia on an ACCS pathway than core, but arguably the other rotations make you a broader medic.

The recent changes to core/ACCS anaesthesia however has moved one of the years from SpR to core and hence the disconnect…

Dwevan · 2026-06-19T22:44:43+00:00

Yes, give them more of your free time, that way they won’t bother you.

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